Joint Contractures, Ulcerations, Severe Raynaud’s Linked to Impaired Hand Function in Scleroderma

The presence of moderate or severe small joint contractures, finger ulcerations, and the severity of Raynaud’s phenomenon show the strongest association with impaired hand function in scleroderma patients, a study reports.

The study, “The association of sociodemographic and disease variables with hand function: a Scleroderma Patient-centered Intervention Network cohort study,” was published in the journal Clinical and Experimental Rheumatology.

Scleroderma is a chronic disease that affects connective tissue, which supports and holds organs together and is also found in the joints. Patients with scleroderma often have impaired hand function, which contributes to disability, a lower quality of life, and limitations in daily activities.

In the study, researchers evaluated “sociodemographic, lifestyle, and disease-related factors that may influence hand function” in scleroderma patients.

The study involved 1,193 participants (88% female; mean age 55.1 years; mean time since diagnosis 9.4 years) enrolled at 37 centers in the U.S., Canada, U.K., France, and Spain. Hand function was measured using the Cochin Hand Function Scale (CHFS). The participants’ mean CHFS score was 13.3.

Results showed that “the presence of digital ulcers, of moderate or severe contractures of the small joints, and patient-reported Raynaud’s phenomenon severity were the most robust independent correlates of impaired hand function in patients with scleroderma,” the researchers stated.

Digital ulcers and Raynaud’s phenomenon (a condition where the fingers and toes feel numb, prickly and frigid in response to cold temperatures or stress) are common clinical features in people with scleroderma.

Being a woman, smoking, having a higher body mass index, and having coexisting rheumatoid arthritis or idiopathic inflammatory myositis (condition characterized by weakness and inflammation of muscles) also showed significant, albeit lower, associations with impaired hand function.

The team also found that moderate alcohol consumption had a positive effect on hand function. The “consumption of 1–7 alcoholic drinks per week was associated with lower CHFS scores (less impaired hand function) compared to no drinking,” they said.

The researchers concluded that “multiple factors may contribute to hand disability in scleroderma, with joint contractures, patient-reported severity of Raynaud’s phenomenon and digital ulcers having the largest associations.”

The team said that “adequately tested prevention strategies, medical treatments, and rehabilitation programs are needed to improve the management of hand function problems” in patients with scleroderma.